Strangers Are Unwilling to Use AEDs in a Pinch

Action Points

Explain that a survey of more than 1,000 people -- some of whom had been trained as first-responders or had medical training -- found that more than half could not recognize an automated external defibrillator and that fewer than half would be willing to use it in an emergency.

The study suggests that more public awareness and training programs should be made available to both increase proficiency in AED use and information that the devices are available in many public places, as possible solutions to the apparent broad lack of knowledge about AEDs and how they are used.

If presented with a situation where you could save someone's life in public with an automated external defibrillator (AED), would you? One survey found less than half of people would be willing to do so.

The cross-sectional survey of more than 1,000 people -- some of whom had first-responder or medical training -- found that more than half could not recognize an AED, and fewer than half would be willing to use the device if the opportunity presented itself, according to Patrick Schober, MD, PhD, of VU University Medical Center in Amsterdam, the Netherlands, and colleagues.

Only a minority of the respondents said they could identify, use, and would be comfortable using a public AED to help restore normal function to a person's heart after cardiac arrest, Schober and co-authors reported in Annals of Emergency Medicine.

The cross-sectional survey gathered data from 1,018 people from 38 countries in the Amsterdam Central Station. Of these, 978 were travelers or visitors, and 45 were building workers or employees of the Dutch railway company.

The Amsterdam rail terminal is equipped with eight AEDs throughout the building -- five of which were in glass-faced green containers labeled "AED" and freely accessible to the public. Therefore, the researchers considered all individuals in the terminal building as potential rescuers and a target population for the survey.

The researchers used two questionnaires that assessed a respondent's ability to recognize an AED, knowledge of public access defibrillation programs, and knowledge about defibrillation in general. On-site investigators would also point to physical AED devices and ask participants to identify the object.

Of all those questioned, 47% could correctly identify an AED when it was pointed to by an investigator (95% CI, 42% to 51%) and 53% said they knew what the device was used for (95% CI, 49% to 58%). Among the small number of building or railway employees, 71% were able to identify the AED.

Only 34% of those asked knew that anyone was allowed to use the device, 49% said that only trained personnel could use it, and 13% thought that only healthcare professionals were permitted to use an AED.

Furthermore, 47% of all respondents said that they would be willing to use the AED if presented with an emergency situation, 43% said they would not be willing to use the device, and 10% were uncertain (95% CI 44% to 50%, 40% to 46%, and 8% to 12%, respectively).

When specifically asked about the device, 64% of those surveyed knew what a defibrillator was used for, but only 43% knew that AEDs were often located in high-traffic areas for public use.

In contrast, 79% of the terminal and railway employees knew what an AED was used for and 93% knew that the device was placed in high-traffic areas for public use.

Additionally, only 6% among all the respondents spontaneously mentioned defibrillation as a course of action in response to a suspected cardiac arrest -- as opposed to 32% of the terminal or railway workers.

A small sample of the respondents included healthcare professionals or individuals who had first-response training. Of these, around one in four were unable to correctly identify an AED and a similar number would not use the device, or were unsure if they would use an AED in a hypothetical emergency situation.

Among the reasons cited for discomfort with using an AED in an emergency included not knowing how the device works, not wanting to harm the victim, or not wanting to be held legally accountable for harm to the victim.

Most countries, including the U.S. and much of Europe, allow lay people to use AEDs and do not hold them legally accountable, the researchers noted.

The researchers noted that the railway terminal used for the survey site was equipped with AEDs throughout the building which could be easily accessed by the public.

The team suggested that more public awareness and training programs should be made available to both increase proficiency in AED use and information that the devices are available in many heavily used public places as possible solutions to the apparent broad lack of knowledge about AEDs and how they are used.

The authors cited a number of limitations in their research, including use of a nonvalidated study instrument (the questionnaire), truthfulness of responses, no count of the number of individuals that refused to participate, and that subgroups of participants from the various countries may not be representative of their native population.

The researchers noted that sudden cardiac death is the leading cause of death in North America and Europe, and use of an AED is often the best way to restart coordinated activity of the heart -- the earlier, the better. What's more, public AEDs are becoming more and more frequently available, they added.

The study was funded by the Department of Anesthesiology, VU University Medical Center, Amsterdam.

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